Feature
Coding the future
How an innovation becomes a billable procedure By Hope Racine
eimbursement dictates more than the average IR’s paycheck: reimbursement rates determine access
to care, available procedures and patient expense. It’s part of the tricky economics of healthcare, and there is nothing as crucial to reimbursement as the management of CPT codes.
One of SIR’s key member benefits is the work that staff and volunteers undertake in both suggesting new CPT codes and helping to value approved codes. It’s an arduous process, but one that relies on the volunteer work of committed SIR members. Over the last 14 years, SIR has led 289 codes through this process
36 IRQ | SUMMER 2024
to allow reimbursement for procedures performed by interventional radiologists.
Creating a code The Current Procedural Terminology, or CPT codes, are overseen by the American Medical Association and created in conjunction with qualified healthcare professionals or associations. These codes describe healthcare services and procedures and are used by Medicare, Medicaid and private insurers to determine reimbursement rates.
CPT code creation or adjustments begin with a healthcare professional or association—such as SIR—suggesting a new code or amendment. These
code change applications include a description of the procedure being done, details on the typical patient who would receive the procedure and any published supporting literature. The code will then be reviewed by the AMA CPT Editorial Panel. From there, it will either be approved, revised or rejected.
“There is so much detail required,” said Raj Ayyagari, MD, of the Boston Medical Center. Dr. Ayyagari spent several months in 2023 creating a code based on an emerging MRI-guided procedure.
This code has not yet finished the long process of being created, valued and accepted. Due to the confidential nature of the CPT creation process, details regarding the procedure or discussions surrounding the code creation are limited.
Dr. Ayyagari was asked to provide clinical expertise to the SIR CPT Editorial Panel and RUC workgroup due to his experience with the procedure, which not many IRs perform yet.
“Physician input, more importantly subspecialty physician input, into code construction is critical,” said Timothy
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